Can laboratory test-based frailty indices contribute to frailty screening in emergency departments?
Background Laboratory-based frailty indices (FI-Labs) offer potential adjuncts and alternatives to clinical assessments. Still, their optimal configuration and construct validity compared with nurse-assessed Clinical Frailty Scale (CFS) scores remain unclear. Methods In this retrospective cohort stu...
| Publicado en: | Age & Ageing Vol. 54; no. 7; pp. 1 - 12 |
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| Autores principales: | , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Jul2025
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=187169233&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 187169233 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jul2025 vid: 54 iid: 7 pid: 622 pub: Oxford University Press / USA artinfo: ui: 187169233 10.1093/ageing/afaf192 ppf: 1 ppct: 11 formats: tig: atl: Can laboratory test-based frailty indices contribute to frailty screening in emergency departments? aug: au: Ellis, Hugh Logan Dunnell, Liam Whitney, Julie Jennings, Cara Wilson, Dan Tippett, Jane Teo, James Ibrahim, Zina Rockwood, Kenneth affil: Department of Biostatistics & Health Informatics, Social Genetic and Developmental Psychiatry Centre, King's College London, Memory Lane, Southwark, London SE5 8AF, UK Department of Medicine, Dalhousie University, Suite 1421-5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 4R2, Canada University Hospital Lewisham, Lewisham, London, UK School of Life Course & Population Sciences, King's College London, London, UK Emergency Department, King's College Hospital NHS Foundation Trust, London, UK Department of Clinical Gerontology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK Neurology Department, King's College Hospital NHS Foundation Trust, London, UK Department of Biostatistics & Health Informatics, King's College London, London, UK su: Retrospective studies Medical screening Reference values Frail elderly Laboratories Hospital emergency services Descriptive statistics Longitudinal method Data analysis software Confidence intervals Proportional hazards models sug: subj: Retrospective studies Medical screening Testing Laboratories Medical Laboratories Veterinary Services All Other Miscellaneous Ambulatory Health Care Services Reference values Frail elderly Laboratories Hospital emergency services Descriptive statistics Longitudinal method Data analysis software Confidence intervals Proportional hazards models keyword: clinical frailty scale emergency department frailty screening laboratory-based frailty index older people reliability clinical frailty scale emergency department frailty screening laboratory-based frailty index older people reliability ab: Background Laboratory-based frailty indices (FI-Labs) offer potential adjuncts and alternatives to clinical assessments. Still, their optimal configuration and construct validity compared with nurse-assessed Clinical Frailty Scale (CFS) scores remain unclear. Methods In this retrospective cohort study, we evaluated five FI-Lab configurations against nurse-assessed CFS scores using data from 74 493 emergency department visits. We examined their association with clinical outcomes and assessed measurement reliability using mixed effects models. Results While nurse assessments demonstrated superior outcome discrimination (c-statistic 0.726 for 90-day mortality versus 0.718 for best FI-Lab), automated FI-Lab measures showed significantly greater between-visit reliability [intraclass correlation coefficient (ICC) = 0.51–0.76 versus 0.37 for nurse CFS]. The drug-adjusted FI-Lab demonstrated highest reliability (ICC = 0.76) but weaker age associations (β = 0.002, P = .08) compared to other configurations (β = 0.006–0.013, P < .001). In complex models adjusting for illness severity, nurse CFS scores showed stronger mortality associations (HR 1.55, 95% CI 1.45–1.66 per standard deviation) compared to FI-Lab configurations (HR range 1.19–1.29). Notably, all frailty measures showed effect sizes comparable to age (HR range 1.37–1.55 per SD). Conclusions Automated FI-Lab measures offer a reliability advantage over nurse-assessed CFS scores despite slightly lower predictive validity for mortality. Their comparable effect sizes to age suggest these automated measures capture clinically meaningful patient characteristics. This trade-off between reliability and predictive validity suggests that integrated approaches combining automated screening with targeted clinical assessment may provide optimal frailty identification in emergency settings. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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